Provider Demographics
NPI:1053866996
Name:CRAWFORD, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E CLARK AVE
Mailing Address - Street 2:SUITE 150 #148
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5178
Mailing Address - Country:US
Mailing Address - Phone:805-717-1060
Mailing Address - Fax:
Practice Address - Street 1:206 GARDEN CT
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93437-1441
Practice Address - Country:US
Practice Address - Phone:805-717-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25965747172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver